the potenal introducon of zika virus into the us – implica ... · giovanini evelim coelho,...
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ThePoten)alIntroduc)onofZikavirusintotheUS–Implica)onsforPublicHealthandBloodSafety–
LessonsLearnedfromOtherArboviruses
SusanL.Stramer,PhDVP,Scien)ficAffairs
ThrombosisandHemostasisSocie)esofNorthAmerica
2016Summit,April15
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NothingtoDisclose
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CurrentArboviralThreatstotheCon)nentalUS
• Dengue:1/3ofworldpopula8onatrisk,30-foldincreasein50yrs• Chikungunya:Re-emergedintheAmericaslate2013;≈1.7Mcases• Zika:evidenceofpastorcurrenttransmissionacrossAfrica,Asia,W.Pacific;confirmedinBrazilMay2015;nowass’dwithmicrocephalyandGuillain-Barrésyndrome;62countriestotalsince2007;33countriesintheAmericasto2016
Dengueriskmaps
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DengueIncidenceisRapidlyIncreasingintheAmericas
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25000001980
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Source:PanAmericanHealthOrganiza8on(PAHO) 4
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27,084suspectedcases
FrenchWestIndes1Dec2013–24Apr2015Guadeloupe:81,350cases
PuertoRico
Mar)nique:72,520cases
PuertoRico:31,433cases
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PuertoRico,PassiveDengueSurveillanceSystem
199917
Oct28,
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SpreadofZIKAVirus(ZIKV)
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SpreadoftheZIKV• 1947:firstdetectedinUganda,Africa
• 1947to2007:14humaninfec)onswerereported(AfricaandAsia)
• 2007:FirstoutbreakinYap,FederatedStatesofMicronesia,Pacific
• 2007to2013:1infec)oninPhilippinesfromretrospec)vestudy
• 2013to2014:AlargeoutbreakoccurredinFrenchPolynesiawith ~32,000symptoma)ccases,11%ofthepopula)on
2.8%rateofRNAinblooddonors,11/42(26%)reportedPDI,viralloads10^3-10^7copies/mL
• 2014:SpreadthroughouttheSouthPacific
• 2015:SpreadtoSouthAmerica(BrazilandColumbia)
Jones KE, Patel NG, Levy MA. et al. Nature 2008 12
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ZIKVpublica)ons:1952-2009(firstdescrip8ontofirstoutbreakinYap)=252010-2015632016225
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Petersenetal.,ZikaVirus;NEJMMarch30,2016
Endemic
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ZIKVVectors:AedesMosquitoes
• Aedes(stegomyia)speciesmosquitoes– Ae.aegyp.mostefficientvectorforhumans
– Ae.albopictusspreadinmoretemperatezones
• Alsotransmitdengueandchikungunyaviruses
• Layeggsindomes8cwater-holdingcontainers;toleratedrying
• Liveinandaroundhouseholds• Aggressiveday8mebiters;canalsobiteatnight
• Mul8plehumansbibenforasinglebloodmeal
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ArbovirusComparisonCharacteris)c Dengue Chikungunya Zika
Virusfamily Flaviviridae Togaviridae Flaviviridae
Virusgenus Flavivirus Alphavirus Flavivirus
Serotypes 4 1 1
Genotypes Mul)pleperserotype 3 2
Vectors Aedesaegyp*Aedesalbopictus
Aedesaegyp*Aedesalbopictus
Aedesaegyp*Aedesalbopictus
Symptoms/illness
Acutefebrileillness
Acutefebrileillness
Acutefebrileillness
Symptoma)c:Asymptoma)c 25:75 75:25 25:75
Illnessoutcome Severedengue–plasmaleakage
Rarelysevere,Arthralgias
Rarelysevere,Microcephaly,Guillian-Barré 16
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ZIKV(forAABBFactSheetPriorto2013)
• Mosquito-borneviraldisease• Zikarecognizedin1947intheZikaforestinUgandaintherhesus
macaques;AfricanlineageandAsianlineage• Usuallymild,las8ngfor2-7days• Mainsymptomsinclude:
– Low-gradefever(<38.5°C)– Transientarthri8s/arthralgiawithpossiblejointswellingmainlyinthe
smallerjointsofthehandsandfeet• Maculopapularrashojenspreadingfromthefacetothebody• Conjunc8valhyperemiaorbilateralnon-purulentconjunc8vi8s• Generalnon-specificsymptomssuchasmyalgia,astheniaandheadaches• Incuba8onperiod3-12days• Infec8onmaygounrecognizedorbemisdiagnosedasdengue,
chikungunyaorotherviralinfec8onsgivingfeverandrash.Asymptoma8cinfec8onsaretherule,≈75%
• Diseaseisusuallymild 17
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ClinicalFeatures:ZIKVComparedtoDengue(DENV)andChikungunya(CHIKV)
Features ZIKV DENV CHIKV
Fever + +++ +++Rash +++ + ++Conjunc)vi)s ++ - -Arthralgia ++ + +++Myalgia + ++ +Headache + ++ ++Hemorrhage - ++ -Shock - + -
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ZIKVandGuillain-BarréSyndrome,2013-2014• ZIKVinfec8onhistoricallywasthoughttoproduceamilddisease• WiththelargeoutbreakinFrenchPolynesia(~32,000cases),ariseincasesof
Guillian-BarréSyndromewasobserved• Pastincidencewasabout5casesperyear• DuringtheZIKVoutbreak,42casesin6months(20Xincrease)
• AllhadZIKVneutralizingan8body• 15admibedtointensivecareunits• FrenchPolynesiaonlyhas270,000inhabitants!
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W1 W3 W5 W7 W9 W11 W13 W15 W17 W19 W21
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cases
ZIKV
cases
WeeksCourtesyofD.Musso
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ZikaandGuillain-BarréSyndrome
OR>34betweenGBSandpriorZIKVinfec8onNow13countries/territoriesreportanincreaseinGBS
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ZIKVGenomefromtheAmericasAsiangenotypemostcloselyrelatedtotheFrenchPolynesian2013strainPa8entwithExanthemaandconjunc8vi8s
Enfissietal.Jan62016TheLancet
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ZIKV-AssociatedMicrocephalytoDec2015
• Ane8ologicroleforZIKVhasnotbeenproven,but…..• ZIKVRNAhasbeenisolatedfromatleast3casesinBrazil,2fromamnio8cfluidoffetuseswithmicrocephalyonultrasoundandonefrombloodand8ssueofababythatdiedatbirth
• 4mothersofmalformedbabiesinFrenchPolynesiahavebeenfoundtohaveIgGan8-ZIKV,buthavenohistoryofcompa8bleillness
• Es8matedrisk1:100infirsttrimester• Diagnos8ctes8ngrequiredtodifferen8ateDENV,CHIKVandZIKV– Note:othercausesincludeinfec8ons(toxo,rubella,herpes,syphilis,CMV,HIV),toxins,alcohol,gene8cabnormali8esandseveremalnutri8onduringpregnancy 22
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ZIKADiseaseinBrazil(Dec82015)1,761reportedin422municipali)esin14Brazilianstateswith19fatali)es
1.PossibleZIKVinfec8onduringpregnancy.2.FetalCNSchangeswithpossiblyrelatedZIKVinfec8onduringpregnancy.3.Miscarriageduetopossibleassocia8onwithZIKVinfec8onduringpregnancy.4.S8llbornduetopossibleinfec8onduringpregnancyZIKV.5.Newbornlivewithmicrocephalypossiblyassociatedwithinfec8onZIKVduringpregnancy.
ProtocolfromtheSecretaryofHealthSurveillanceremonitoringforZIKV-associatedmicrocephalyandfetalmalforma)ons:
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RatesofMicrocephalyOverTime:theAmericasandtheCaribbean
20-foldincreaseinratesofmicrocephalyintheAmericasandCaribbeanfrom2010-2014and2015
Source:PanAmericanHealthOrganiza)on,Epidemiologicalupdate,17January2016
MicrocephalyratesbystateinBrazil(casesper1,000livebirths)
EpiWeek522015
Countrylimits
BrazilStateBoundaries
0.1-1.01.1-15.015.1-30.030.1-45.0
45.1-88.6
Countries
CountrieswithZikaconfirmedcases
UpdatedasofEpidemiologicalWeek52(December27,2015–January2,2016)
DataSource:ReportedfromtheIHRNa8onalFocalPointsandthroughtheMinistryofHealthwebsites.
MapProduc)on:PAHO-WHOADCHAIRARO
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ZIKVinBrazil• Es8matednumberofinfec8ons– 498,000to1,482,000
• 27/27stateshavereportedcasesofmicrocephaly
• 2982reportedcasesin2015• 2908reportedcasesin2016(thruMarch27)– Previously147-175(2010-2014)
• 907confirmedplus4293underinves8ga8on
• 46confirmeddeaths– 130underinves8ga8on
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Feb102016
PregnantfemalereturnsfromRioGrandedoNortestate;weeks20-28normalpregnancyDuring13thweek,shehadhighfever,musculoskeletalandretroorbitalpain,itchingandrashAbnormali8esatweek32=>pregnancyterminated
intrauterinegrowthretarda8on,microcephaly,brainstructuresblurred,extremelycalcified(includingtheplacenta),severebraindiseasenoothercausesofmicrocephaly(family)
ZIKVRNAbyRT-PCR6.5x10^7copies/mgbrain8ssue;allotherflavivirusesandothervirusesnegFullgenomesequencedfromthefetalbrain;densepar8clesresemblingvirusand
envelopedstructuresresemblingreplica8vecomplexesalsoobserved99.7%gene8crelatednesstoFrenchPolynesia2013strainandSaoPaulo2015strainNopresenceofZIKVandnopathologicalfindingsdetectedinanyotherfetalorgans=>Strongneurotropismofthevirus
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ZikavirusintheAmericas:Earlyepidemiologicalandgene)cfindings–
Casesappeared2yearsa=eritsintroduc*onintoBrazil
by Nuno Rodrigues Faria, Raimunda do Socorro da Silva Azevedo, Moritz U. G. Kraemer, Renato Souza, Mariana Sequetin Cunha, Sarah C. Hill, Julien Thézé,
Michael B. Bonsall, Thomas A. Bowden, Ilona Rissanen, Iray Maria Rocco, Juliana Silva Nogueira, Adriana Yurika Maeda, Fernanda Giseli da Silva Vasami, Fernando Luiz de Lima Macedo, Akemi Suzuki, Sueli Guerreiro Rodrigues, Ana Cecilia Ribeiro
Cruz, Bruno Tardeli Nunes, Daniele Barbosa de Almeida Medeiros, Daniela Sueli Guerreiro Rodrigues, Alice Louize Nunes Queiroz, Eliana Vieira Pinto da Silva, Daniele
Freitas Henriques, Elisabeth Salbe Travassos da Rosa, Consuelo Silva de Oliveira, Livia Caricio Martins, Helena Baldez Vasconcelos, Livia Medeiros Neves Casseb,
Darlene de Brito Simith, Jane P. Messina, Leandro Abade, José Lourenço, Luiz Carlos Junior Alcantara, Maricélia Maia de Lima, Marta Giovanetti, Simon I. Hay, Rodrigo Santos de Oliveira, Poliana da Silva Lemos, Layanna Freitas de Oliveira, Clayton Pereira Silva de Lima, Sandro Patroca da Silva, Janaina Mota de Vasconcelos,
Luciano Franco, Jedson Ferreira Cardoso, João Lídio da Silva Gonçalves Vianez-Júnior, Daiana Mir, Gonzalo Bello, Edson Delatorre, Kamran Khan, Marisa Creatore,
Giovanini Evelim Coelho, Wanderson Kleber de Oliveira, Robert Tesh, Oliver G. Pybus, Marcio R. T. Nunes, and Pedro F. C. Vasconcelos
Published by AAAS 28
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Fig.1TimeseriesandcartographyofreportedZIKVandmicrocephalycasesinBrazil
Nuno Rodrigues Faria et al. Science 2016;science.aaf5036
Published by AAAS 29
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Fig.2MaximumlikelihoodphylogenyofZIKVcompletecodingregionsequences
Nuno Rodrigues Faria et al. Science 2016;science.aaf5036 Published by AAAS 30
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Fig.3Timescaleoftheintroduc)onofZIKVtotheAmericas
Nuno Rodrigues Faria et al. Science 2016;science.aaf5036 Published by AAAS 31
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OthermodesofZIKVtransmission(otherthanmosquito,intrauterine)• Sexual
– 2healthcareworkersreturnedfromSenegalin2008(Foyetal.EID2011fromCDC)
• Sexualtxfromcase1tohiswife(case3)uponreturntoCO• Sexualintercourse1dayajerhisreturn;3dayslater,case1developedprosta88s,hematospermiaandhiswifedevelopedflu-likeillness;shehadnotravelhistoryorknownmosquitoexposure;semenwasnotinves8gatedforRNAbutbothtestedZIKVseroposi8ve
– ZIKVRNAisolatedfromsemenandurinepublishedinEID,Feb2015bygroupinTahi8(Mussoetal.)
• Fever,weaknessdays1-3;arthralgiadays5-7• Hematospermia2weekslater;ZIKARNAposfromsemen;repeated3dayslaterandconfirmedinsemen(10^7copies/mL)andurine(10^3copies/mL);bloodnega8ve;virusalsocultureposfromsemen
– ZIKVRNArecoveredfromsemenofapa8entreturningfromtheCookIslandsondays27and62ajersymptomonset(Atkinsonetal.,EID2016)
– Casesinves8gatedintheUS(6countriesnowrepor8ng)32
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Detec)onofZIKVinUrine;Gouriantetal.,EID;Jan2015
Wedescribethekine8csofZikavirus(ZIKV)detec8oninserumandurinesamplesof6pa8ents.Urinesampleswereposi8veforZIKV>10daysajeronsetofdisease,whichwasanotablylongerperiodthanforserumsamples
Triangles=urine;squares=serumDashedlineindicates>2dayintervalbetweensampling 33
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ViralRamp-upStudyin3MacaquesinfectedwithZIKV
hbps://zika.labkey.com/project/OConner/begin.view
10^6copies/mL
10^4copies/mL
10^4copies/mL
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Rossietal.,2016
MicelackingIFNreceptorsupportdiseaseandmortalitywhenZIKVchallengedAgedependentresponse(3wo=>deathvs11week=>diseasebutrecovered)Growthinthebrainbyday3withneurologicdiseasebyday6Robustreplica8oninthetestes
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OthermodesofZIKVtransmission• Transfusion-highviral8tersupto14days
– 2casesfromBrazil(bothCampinas,SaoPauloState)– FirstMarch2015reportedtoHV
• 3dayspost-dona8on,reportDENV-likesymptomsfromdonor,laterdiagnosedasZIKV=>ZIKVRNApos(negDENV/CHIKV)
• Platelets=>liverrecipient,remainedasymptoma8cforZIKV,butRNApos(andculturepos;pre-txsampleneg)
• Sequenceiden8tybetweendonor/recipient– 2ndcaseApril2015
• Gunshotvic8mrec’d18components=>died• Recipientunexplainedthrombocytopeniapriortodeath;ZIKVculturepos(negDENV/CHIKV)
• Reten8onsamplesfrom18componentswerepartofarepositorystudy=>iden8fiedoneZIKVRNAposcomponentreceivedbyrecipient
• 3dayspost-dona8on,donorreportedsymptoms:rash,conjunc8vi8s,severeitching,generalizedpain,hypotension 36
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UpdatedZIKVInfo(4/10/16)• CDCPublicHealthalerts–41areasincluding33intheAmericas,7
islandsintheS.Pacific,and1Africa(CapeVerde)– Usualmosquitoavoidancemeasures,DEET,longsleeves,pants,sleepunderabednet,removestandingwater
– Pregnantwomenavoidtravel;condoms,avoidcontactwithsemen
• Feb1WHOdeclarespublichealthemergencyofinterna8onalconcerntotriggeracoordinatedglobaleffortforeduca8on,surveillance,diagnos8cs,treatment,preven8on(mosquitocontrolandvaccinedevelopment),researchintocongenitalmalforma8onsandneurologicalcomplica8ons– Only4thinrecentyears:EBOV,Polio,H1N1flu– Est’d3-4millioncasesintheAmericasinthenext12monthsmodeledajerDENVintheAmericasin2015with~2millioncases(A.aegyp.inthe“dengue-belt”)
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AllCountriesandTerritorieswithAc)veZikaVirusTransmission(4/10/16)
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Considera)onsforBloodSafety
• Surveillance• Stopcollec8onsandrelyonimports• Enhanceddonorsymptomscreening• Enhancedcallback(PDI)=>Quaran8ne• 14-or28-daytraveldeferralsusedinnonendemicareas
• Rou8neblooddona8ontes8ng(NAT)• Pathogeninac8va8on
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Detec)ngZIKVRNAandan)bodies
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Inac)va)onofEmergingPathogens
Pathogen Inac)va)onInPC(Log10)WestNilevirus >6.0
Chikungunyavirus >6.4H1N1virus >4.1H5N1virus >5.9
Dengueviruses >5.0SARS-HCoV >6.3
ParvovirusB19 4=>5.5Orien*atsutsugamushi >5.5Trypanosomacruzi >5.3Babesiamicro* >5.3
Leishmaniamexicana >5.041
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Valida)onofInterceptinac)va)onforZIKVinplasmaunits
Aubryetal.Transfusion2016
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FDAGuidance2/16/16• Areaswithac)veZIKVtransmission;2-weekimplementa8on(March1)orimmediateforpregnantwomen,intrauterinetransfusionorotherriskgroupsasdefinedbythephysician;excep8onsrequirephysicianapprovalifdeemedurgent– ObtainwholebloodandcomponentsfortxfromareasoftheUSwherenoac8vetxisoccurring
– CanprepareplateletsandplasmausinganFDA-approvedPImethod(ormethodapprovedunderIDE)
– CantestusingalicensedNAT(ormethodapprovedunderIND)
– DHQmodifiedtoaskaboutadxors/s(cdc.gov)ofZIKVinfec8oninthepast4weeks;historyofsexualcontactinthepast4weekswithamanwhohasbeendxwithorhads/ssugges8veofZIKVinthe3monthspriortothelastsexualcontact 43
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FDAGuidance2/16/16• Areaswithoutac)veZIKAtransmission;4-weekimplementa8on(March15)– Donoreduca8onalmaterialsallowingdonorstoselfdeferfor4weeks
• Riskfactorsands/sofZIKVinfec8onwithinthelast2weeksofleavinganac8veZIKVarea(cdc.gov)
• HistoryofZIKVinfec8onun8l4weeksajerresolu8onofsymptoms• SexwithamanwhohasbeendxwithZIKVorwhotraveledtoorresidedinanac8veZIKVareainthe3monthspriortothelastsexualcontact
• Travelnotspecificallymen8oned,butshouldbeincluded(riskfactors)– DHQmodifiedtoaskaboutresidenceortravelw/inlast4weeks(cdc.gov)
– PDIasabovewithdonordeferralfor4weeks– Productquaran8ne/retrievalofindatecomponentsforthosecollectedfromadonoratriskordxduringthe4-weekdeferralperiodorreportedasPDIwithinsubsequent2weeksofcollec8on;consigneeno8fica8onfromadonorwithaZIKVdxwithintheprior4weeksofdona8onor2weeksfollowingdona8on
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ZIKVSigns/Symptoms(2ormore)fromcdc.gov
• Fever• Rash• Jointpain• Musclepain• Conjunc8vi8s(redeyes)• Headache
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Es)mateddonordeferralrate(%)intheUSfroma14-or28-daydeferralbygeographicregion
comparing2surveysAreaoftravelinthepast:
SummerSurvey(Aug-Sept2014)Fixedsitesonly;papersurvey;
AmericasonlyprimarilyN=33,408
WinterSurvey(March2015)Allsites;electronicsurvey;
WorldwideN=19,879
14-day% 28-day% 14-day% 28-day%Mexico 0.19 0.52 0.40 0.92
Caribbean 0.16 0.48 0.48 1.18Centraland
SouthAmerica0.05 0.13 0.20 0.46
Allabove* 0.39 1.17 0.97 2.25Alltravel(global)*
N/A 2.64 1.35 3.96
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*Individualareasandsumsarenotthesameduetoincompleterepor)ngoftraveldes)na)onandtraveltomul)pleplaces.Spenceretal.,AABB2015;Plenary
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AdaptedfromBogochetal.,TheLancetJan142016
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ZIKVdiseasecasesreportedtoCDCbyUSstateorterritory—2015–2016
(4/10/16)
LocalTravelContUS0346Territories3513
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SequencingPRNT
EmergencyUseAuthoriza)on:TrioplexReal-)meRT-PCRforDENV,CHIKVandZIKVmul)plexrRT-PCRandZIKVMAC-ELISA(bothCDCassays) 50
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*Mapsupdatedfromavarietyofsources;theyrepresentCDC'sbestes8mateofthepoten8alrangeofAedesaegyp.andAedesalbopictusintheUS.Mapsarenotmeanttorepresentriskforspreadofdisease.
ESTIMATEDrangeofAedesaegyp*andAedesalbopictusintheUS,2016Maps
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Thismapes)mateswhichUSci)esfacethehighestriskfromZIKV
hbp://www.sciencealert.com/this-map-es8mates-which-us-ci8es-face-the-highest-risk-from-zika-virus 52
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ZikaisComing;NYTimesApril92016;PeterHotezPredictedLoca)onsofAedesaegyp*intheSouthernUS
Factorsfavoringtransmission/spreadofZIKV:Aedesaegyp*,overcrowding,extremepoverty.“Incrowdedplaces,mosquitoeshavelotsofaccesstolotsofpeople.Poorpeopleojenliveinproximitytogarbage,includingold8res,plas8ccontainersanddrainageditchesfilledwithstagnantwater,wherethisspeciesofmosquitolivesandbreeds.Andtheyojenhavehomeswithtornscreensontheirwindows.” 53
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Poten)alforlocaltransmissionislikelylow(astakenfromCDPH)
AviremicpersonwouldneedtoreturntoaregionwherethereareAedesmosquitoesandbebibenbyanAedesmosquitothatliveslongenoughtobecomeinfec8ousandbiteanotherperson
Aedestakes10-11daystobecomeinfec8ousajerbecominginfectedandthattheaveragelifespanisonly14daysThus,manyinfectedmosquitoeswilldiebeforebeingabletotransmitMi8ga8ngfactors:PatchyAedesaegyp.andalbopictusdistribu8onUseofaircondi8oners,windowanddoorscreensBeberwatermanagementthaninothercountriesGoodmosquitocontrol!
Ifanoutbreakweretooccur,itwouldlikelybelimitedinscopeanddura8onThefewlocaloutbreaksofDENVandCHIKVintheUShavebeencontainedTherefore,theUSwillprobablynotexperiencethesameextensiveoutbreakscurrentlybeingexperiencedinLa8nAmerica
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DENV CHIKV
Year Local Imported Local Imported
2014 7(FL) 654 12(FL) 2799
2015 1(FL) 540 0 679
ComparisonofUS-reportedcasesofDENVandCHIKVtotheCDC,2014-2015
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ZIKVcasesduetobloodtransfusionhavebeenreported–noneinUSyet!
(astakenfromCDPH)
Upondetec8onoflocalZIKVtransmissioninanystatelocalpublichealthagencieswouldinves8gateandenhancesurveillanceandmosquitocontrolintheareaBloodbankswouldbeinformedoflocaltransmissionsothatdonorsfromthearea(tobedefined)wouldbedeferredfromdona8ngbloodun8lbloodscreeningisinplace
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KeyMessages(astakenfromCDPH)
Riskoflocaltransmissionofchikungunya,dengue,andZikavirusesintheUSislikelylowHowever,transmissionispossibleandwemustbepreparedtoaggressivelyrespondonceacasewithouttravelhistoryhasbeenreported
OngoingsurveillanceandcontrolofAedesarecri8calIndividualswithZika,dengue,orchikungunyashouldbeinformedtotakeprecau8onstoavoidmosquitobitesduringillnesstoavoidini8a8nglocaltransmissionShouldtherebelocaltransmission,theareaofexposureriskwouldbedeterminedbasedonhumanandmosquitosurveillancedataandgeographicboundaries,suchaszipcode,city,orcountywouldbedefinedandreported 57
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• Providestateandlocalseniorofficialswithinforma8onandtoolsneededtoimproveZikapreparednessandresponsewithintheirstatesandjurisdic8ons.• IncreaseknowledgeonthelatestZikascience,includingimplica8onsforpregnantwomen.• Increaseknowledgeofbestcommunica8onsprac8ces,includingcrisisandriskcommunica8onprinciples.• AcceleratereadinessforlocalZikatransmissionthroughtrainingandtechnicalassistancetostatestohelpestablishandsupportsurveillanceandsharebestprac8cesforvectorcontrol.• Iden8fypossiblegapsinpreparednessandresponseatthefederal,state,andlocallevels;begintoaddresspossiblegaps. April1,2016 58
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Defini)onofareasofac)vevector-bornetransmissionthatwouldac)vatebloodsafetyinterven)on(includingFDAguidance)–DRAFTCONCEPT
Twoormorelaboratory-confirmedinfec8onsduetolocalvector-bornetransmission(e.g.,notravelhistory,nocommonsexualexposure),andepidemiologicallyunrelatedtoeachother(e.g.,notsamehousehold)occurringwithintwoweeksinanaffectedarea Theaffectedjurisdic8onwilldetermine,onthebasisofsurveillance,popula8ondensityandvectorecology,anareaoflikelylocaltransmissionanddefinesuchareaonthebasisofaclusterofZIPcodes.ThisclusterofZIPcodeswillbedefinedastheareaofinterven8onTheclusterofZIPcodeswillbereportedbytheStatetotheCDC 59
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Issues• Bloodsafety
– Screeningshouldbeinplacepriortoappearanceofvirus=>outbreaks–notthecurrentmodel
• Mosquitocontrol– Tradi8onalmethodsineffec8veagainstAedes– Biologic/gene8cvectorcontrol
• Infectedorengineeredmosquitoestoyieldsterileoffspring
• Vaccine– Timefordevelopment– An8body-dependentenhancement(ADE);wouldpriorflavivirusvaccina8on(YFV)orpriorprimaryinfec8on,orZIKVvaccineexacerbatediseaseinasecondaryinfec8on?
• Vaccine-inducedGuillain-Barrésyndrome 60
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ZIKVcontrolrequiresanurgentandcoordinatedresponse
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